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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191871630
Report Date: 06/29/2022
Date Signed: 06/30/2022 08:53:13 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2022 and conducted by Evaluator Lissete Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220608103951
FACILITY NAME:LA MIRADA HEAD STARTFACILITY NUMBER:
191871630
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:5637 LA MIRADA AVE.TELEPHONE:
(323) 464-6982
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY:75CENSUS: 0DATE:
06/29/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jocelyn Tucker, Assistant DirectorTIME COMPLETED:
09:48 AM
ALLEGATION(S):
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Daycare child sustained bruises while in care.
INVESTIGATION FINDINGS:
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At 9:30AM on June 29, 2022, Licensing Program Analyst (LPA) Lissete Gonzalez conducted a Complaint Inspection to conclude the investigation regarding the above complaint allegation. LPA contacted Assistant Director, Jocelyn Tucker, via telephone due to La Mirada Head Start’s summer closure schedule. The facility is closed for summer break from June 23, 2022 through September 12, 2022. At 9:32AM the call was transferred to a Zoom virtual meeting to complete the tele-inspection. There were no children present.

Pertaining to the allegation, Daycare child sustained bruises while in care, during this investigation LPA obtained a copy of the children’s roster, ouch reports, care and supervision zoning maps, staff training agenda, and other documentation. LPA conducted interviews with the reporting party, staff #1, staff #2, staff #3, child #1, and other witnesses. There were no disclosures to corroborate the allegation or evidence to support the allegation. Although the allegation may have happened or is valid there is not a

REPORT CONTINUES ON NEXT PAGE: 1 OF 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 33-CC-20220608103951
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LA MIRADA HEAD START
FACILITY NUMBER: 191871630
VISIT DATE: 06/29/2022
NARRATIVE
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preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's tele-inspection.

Exit interview conducted and report was reviewed with the facility representative, Jocelyn Tucker.

A copy the report (LIC 9099) and Appeal Rights (LIC 9058) were sent via email to the facility representative. An electronic read receipt confirms receipt of the reports. The facility representative was provided with the mailing address to the Monterey Park Regional Office (1000 Corporate Center Drive, Suite 200B, Monterey Park, CA 91754) and agrees to send a copy of the signed LIC 9099 reports by email to LPA Gonzalez by the close of business day on June 29, 2022 and mail the original forms to the regional office.


END OF REPORT PAGE: 2 OF 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2